Donald Trump really hates George Washington University's Hurricane Maria mortality report. Well, maybe not the report, because lord knows the orangutan with the mushroom dick didn't read it, like I did! It's 69 pages, he ain't got time for that! Pendejo hates the 2975 that is flashed all over the place as the official death toll. The fact is, the number is an estimate, not an actual count of for sure people who died because of the hurricane. Still, if he'd bother to read the report, rather than spend his time dyeing his Yeti pubes all night, he'd see that while it's an estimate, it's a pretty solid analysis. Shall we delve into the report, amigos? Claro que si!

Why was this report/study even done? The governor of Puerto Rico wanted an independent assessment and he commissioned the school of public health at George Washington University. Seventeen scientists worked on this directly and also used an additional expert panel of nine smart peeps. Why did Ricardo Rossello do this? Because he's a fucking scientist baybee, and he wanted DATA to find out how badly Mother Nature and Father Mushroom screwed his island. The report has three parts. The first is the one that calculates the 2975 estimate, the second part looks at how well the death certification process went, and the third part assesses how communications regarding the deaths took place. The period studied for all three was from September 2017 through February 2018.

Let's tackle them in order, but I'll focus on the first one.

"EXCESS MORTALITY ESTIMATION"

Because the death certificates weren't adequately completed to simply count up "death due to hurricane," the team had to come up with another approach. Simply put, they counted up how many actual deaths occurred in the time frame and compared that to what would have been predicted based on historical mortality. The "would have been predicted" is where we get a bit squishy and where some reasonable debate could be had. To add complexity, the GWU team took into account that after a natural disaster there is migration out of the area, what they term the "displacement scenario." This means that there were fewer people ON the island than before and therefore, that denominator should be used for the mortality calculation. Now, I'm not an epidemiologist, so if one you gentle readers is, please do chime in here.

Here's a quote from the report on that:

The Puerto Rico Vital Statistics Registry (PRVSR) documented 16,608 deaths from September 2017 to February 2018—9,054 males and 7,554 females. Approximately 77% were older adults (65+ years), and 18% resided in the municipalities with low socioeconomic development. We estimated that in mid-September 2017 there were 3,327,917 inhabitants and in mid-February 2018 this number was 3,048,173 inhabitants of Puerto Rico, a total population reduction of approximately 8%. This was factored into the migration "displacement scenario" and compared with the "census scenario." Age-adjusted mortality rates for Puerto Rico tend to be higher in the winter and early spring, declining in the summer months (Figure 1). Mortality has been slowly declining from 2010 on, but increased markedly in the period after September 2017, most dramatically under the displacement scenario accounting for migration after the hurricane."

They created a statistical model based on that, which gave them the predicted values in the table below. They then just subtracted that number from the actual observed deaths and came up with the 2975 hurricane attributable deaths. Now, in their report, they rightfully present it as an estimate and as you can see in the table, list the 95 percentile confidence range of 2658 to 3290 deaths. THAT's how I'd present the data in the media. Without reading the report, even though I SAW the word "estimate" on all the news reports, my brain ignored that and focused on the false implied precision of four significant digits in 2975 Puerto Rico deaths. "Approximately 3000" would have been better, I think.

Again, here's why simply using death certificates was not appropriate:

The official government estimate of 64 deaths from the hurricane is low primarily because the conventions used for causal attribution only allowed for classification of deaths attributable directly to the storm, e.g., those caused by structural collapse, flying debris, floods and drownings (see below). During our broader study, we found that many physicians were not oriented in the appropriate certification protocol. This translated into an inadequate indicator for monitoring mortality in the hurricane's aftermath. Verification of attribution takes time, while excess mortality estimation is a more immediate indicator.

Not shocking, but when they analyzed the deaths by socioeconomic status, the poor people did worse than the not so poor.

"DEATH CERTIFICATION PROCESS EVALUATION"

Multiple problems here. We covered that you can't just count the direct deaths only as that minimizes the mortality impact. However, the study found that physicians lacked awareness of the appropriate way to log deaths after a natural disaster. They also found that the government of Puerto Rico didn't communicate to physicians about proper reporting of deaths prior to the 2017 hurricane season. When the GWU investigators asked physicians about CDC guidelines that the PRVSR had circulated right after the hurricane, the physicians seemed confused and some voiced concerns about possible liability to them. Many physicians also stated that they weren't notified about the importance of correctly documenting deaths.

"ASSESSMENT OF CRISIS AND MORTALITY COMMUNICATIONS AND THE INFORMATION ENVIRONMENT"

Multiple problems here too. None of the Puerto Rico government agencies had any appropriate crisis and emergency communications plan in place. What they did have was not designed for hurricanes greater than Category 1 and further. Regardless, of the key leaders interviewed by the study folk, all stated that the local agencies stepped up and filled the communication gap. The report mentions other errors, but one that stood out to me was that "efforts undertaken by outside groups to fill information gaps and identify hurricane-related deaths added to conflicting mortality reports in the information environment." Take a look at this Harvard (Hahvaad as we say around here) study that overinflates the number to 4645 deaths due to faulty sampling and focusing on the midpoint of a broad 95th percentile range (793 to 8498).

If you want more details and their recommendations which I didn't have room to cover, the report is very readable and right HERE.

Or if you want to read a classic sci fi that may be where we are headed with climate change, stronger and more frequent hurricanes, take a gander at The Drowned World by J. G. Ballard. It's Heart of Darkness meets Waterworld and pretty damn great.